Madeleine Warwick1, Shannon M Fernando2,3, Shawn D Aaron4,5,6, Bram Rochwerg7,8, Alexandre Tran5,9, Kednapa Thavorn5,6, Sunita Mulpuru4,5,6, Daniel I McIsaac5,6,10, Laura H Thompson6, Peter Tanuseputro5,6,11,12, Kwadwo Kyeremanteng2,6,11,13. 1. Division of Respirology and Sleep Medicine, Department of Medicine, 4257Queen's University, Kingston, Ontario, Canada. 2. Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ontario, Canada. 3. Department of Emergency Medicine, 6363University of Ottawa, Ontario, Canada. 4. Division of Respiratory Medicine, Department of Medicine, 6363University of Ottawa, Ontario, Canada. 5. School of Epidemiology and Public Health, 6363University of Ottawa, Ontario, Canada. 6. Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ontario, Canada. 7. Department of Medicine, Division of Critical Care, 3710McMaster University, Hamilton, Ontario, Canada. 8. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. 9. Department of Surgery, 6363University of Ottawa, Ontario, Canada. 10. Department of Anesthesiology and Pain Medicine, 6363University of Ottawa, Ontario, Canada. 11. Division of Palliative Care, Department of Medicine, University of Ottawa, Ontario, Canada. 12. Bruyère Research Institute, Ottawa, Ontario, Canada. 13. Institut du Savoir Montfort, Ottawa, Ontario, Canada.
Abstract
PURPOSE: Chronic obstructive pulmonary disease (COPD) is a common condition, accounting for a significant number of intensive care unit (ICU) admissions. However, little is known about outcomes and costs among ICU patients admitted with acute exacerbations of COPD (AECOPD). We studied predictors of inhospital mortality and costs of ICU admissions for AECOPD. METHODS: Data were obtained from a prospectively maintained registry from 2 ICUs from 2011 to 2016, including adult patients (age ≥ 18) with an ICU discharge diagnosis of AECOPD. The primary outcome was hospital mortality. Secondary outcomes included ICU length of stay, resource utilization, total hospital costs, and cost per survivor. RESULTS: We included 390 patients, of which 27.2% died in hospital. Independent predictors of inhospital mortality included age (odds ratio [OR]: 1.95, CI: 1.58-2.67) and the presence of clinical frailty (OR: 4.12, CI: 2.26-6.95). The mean total hospital costs were Can$35 059, with a cost per survivor of Can$48 191. Factors associated with increased cost included transfer from an inpatient setting, severity of illness, and previous ICU admission. CONCLUSIONS: Approximately a quarter of patients admitted to ICU with AECOPD died during hospitalization, and these patients accrued significant costs. This study identifies important factors associated with poor outcome in this at-risk population, which has value in risk stratification and patient or family discussions addressing goals of care.
PURPOSE: Chronic obstructive pulmonary disease (COPD) is a common condition, accounting for a significant number of intensive care unit (ICU) admissions. However, little is known about outcomes and costs among ICU patients admitted with acute exacerbations of COPD (AECOPD). We studied predictors of inhospital mortality and costs of ICU admissions for AECOPD. METHODS: Data were obtained from a prospectively maintained registry from 2 ICUs from 2011 to 2016, including adult patients (age ≥ 18) with an ICU discharge diagnosis of AECOPD. The primary outcome was hospital mortality. Secondary outcomes included ICU length of stay, resource utilization, total hospital costs, and cost per survivor. RESULTS: We included 390 patients, of which 27.2% died in hospital. Independent predictors of inhospital mortality included age (odds ratio [OR]: 1.95, CI: 1.58-2.67) and the presence of clinical frailty (OR: 4.12, CI: 2.26-6.95). The mean total hospital costs were Can$35 059, with a cost per survivor of Can$48 191. Factors associated with increased cost included transfer from an inpatient setting, severity of illness, and previous ICU admission. CONCLUSIONS: Approximately a quarter of patients admitted to ICU with AECOPD died during hospitalization, and these patients accrued significant costs. This study identifies important factors associated with poor outcome in this at-risk population, which has value in risk stratification and patient or family discussions addressing goals of care.
Authors: Elizabeth Smith; Max Thomas; Ebru Calik-Kutukcu; Irene Torres-Sánchez; Maria Granados-Santiago; Juan Carlos Quijano-Campos; Karl Sylvester; Chris Burtin; Andreja Sajnic; Jana De Brandt; Joana Cruz Journal: ERJ Open Res Date: 2021-02-08
Authors: Kara M Plotnikoff; Karla D Krewulak; Laura Hernández; Krista Spence; Nadine Foster; Shelly Longmore; Sharon E Straus; Daniel J Niven; Jeanna Parsons Leigh; Henry T Stelfox; Kirsten M Fiest Journal: Crit Care Date: 2021-12-17 Impact factor: 9.097
Authors: Ross T Prager; Michael T Pratte; Laura H Thompson; Kylie E McNeill; Christina Milani; David M Maslove; Shannon M Fernando; Kwadwo Kyeremanteng Journal: Crit Care Explor Date: 2021-12-09